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Obamacare Explained: After so many complaints, a success story


We’re a newspaper, so people usually call us just to complain.

That’s why a recent tweet to us about a positive experience buying coverage under the Affordable Care Act caught our eye. We thought this consumer’s story might guide others looking to buy a plan in what’s sometimes a confusing marketplace.

Also this week, a local broker explains why the “young invincibles” really aren’t buying health insurance, and how the market can help them get covered.

■ Stacy Calvert tweeted: Thank you (Nevada Health CO-OP) for making my mother’s day. Signed my parents up for ACA today with ease!

Before we explain how Calvert helped her folks find a plan, a little background: Calvert lives in Illinois, where she’s a graduate student studying media arts. Her parents have been uninsured since they moved here in 2012. Calvert’s mom, 62, is out of work, and her dad, 63, took sales jobs with no benefits. What’s more, Calvert’s parents have pre-existing conditions: Her mom has had strokes, and her dad has an ailment that causes blood clots.

Before Jan. 1, any insurance her parents could find was prohibitively expensive, Calvert said, and no plan would have covered those existing health problems.

Enter Nevada Health CO-OP, a nonprofit insurer created by the Affordable Care Act to provide consumers a locally run, membership-directed carrier.

Calvert visited last week to help her parents while her dad had surgery — more on that in a minute — and while she was here, she took her mom to the CO-OP’s walk-in enrollment center at 3900 Meadows Lane. The enrollment counselor there was “fantastic,” Calvert said.

“She was so nice and helpful, and she really explained stuff to us,” she said. “She said to my mom, ‘I’m your health advocate. I’m going to be here for you. If you have any issues, call me directly.’ ”

Calvert’s mom left with a policy for her and her husband that costs $215 a month. The deductible is $1,500 to $3,000.

“That’s amazing to me that they’re going to pay that for both of them. With all of the medical (stuff) they have to deal with, that is unbelievable,” Calvert said.

The coverage doesn’t take effect until April 1, which means it won’t pay for the partial leg amputation Calvert’s dad had Saturday — a surgery Calvert blamed on blood clots that went untreated while her parents were uninsured. But Calvert said University Medical Center is working to help the family with its bills.

So what lessons can we gather?

First, if you want to buy coverage and you’re having trouble getting through the process at the state exchange’s Nevada Health Link website, find a knowledgeable person to help. Calvert said her dad tried to buy through the exchange site, but got a more expensive quote than what the family found going directly to the CO-OP.

“It was helpful sitting with someone who went over things with us and found the specifics they needed to get their premium,” she said.

Second, don’t panic.

“People just need to take a deep breath and not get freaked out about the (Affordable Care Act), because I really think it’s there to help people,” she said. “People like my parents can get coverage for a price that’s affordable.”

■ Some consumers aren’t quite as excited about the law as the Calverts are.

The “young invincibles” — healthy people younger than 35 — aren’t buying coverage in nearly the numbers public officials expected.

Just 27.1 percent of paid Nevada Health Link enrollees were younger than 35, as of February. That’s below the 40 percent that federal officials said exchanges needed to avoid the “death spiral” that comes from ever-rising premiums when the insurance pool is older and sicker.

The consensus is that younger consumers aren’t enrolling because they don’t believe they need care — hence the “young invincibles” label.

But Chris Carothers, president of Carothers Insurance Agency, said that’s not often the case.

“The young are not buying because they were looking for help affording premiums, and there is no help, and they cannot afford coverage,” Carothers said.

Two issues are causing affordability troubles, Carothers said. One is real; the other is about perceptions.

Start with the real problem: The federal government says people making less than $46,000 a year can qualify for a tax credit that subsidizes their premium. The thing is, that subsidy is based partly on how much your plan costs, and the younger you are, the lower your premiums. And lower premiums mean less of a tax credit. In practice, most locals must be at least 47 to pay enough in premiums to get a subsidy, Carothers said.

Essentially, 20-somethings in Clark County get a subsidy only if they make less than $29,000 a year.

Then there’s the perception problem.

“Coverage under the Affordable Care Act was oversold as low-cost, or even free,” Carothers said. “People would tell us they were waiting for their ‘free Obamacare health care.’ That was the effect — ‘the government is going to take care of me.’ People have discovered that isn’t going to happen.”

An informational campaign could help reverse the tide, Carothers said.

“We need to remind businesses that it’s a liability to not offer coverage, because employees may be less productive if they’re worried about their health care. We could talk to these young adults about the need for them to get covered. If their employer offers benefits, it’s easy to sign up. If their employer doesn’t offer coverage, we need to talk to them about buying an individual plan. People need to realize it’s not that complicated.”

■ The Silver State Health Insurance Exchange is looking in earnest for an executive director to replace Jon Hager, who resigned Friday. The exchange posted a job description and qualifications for the position on its Twitter feed Tuesday.

The post pays as much as $117,030 a year, plus benefits that include participation in the state’s Public Employees Retirement System, 11 paid holidays a year, and annual accrual of three weeks of leave and three weeks of sick leave. To be in the running, you need at least a decade of “high-level” experience in health insurance and “demonstrated knowledge” of Obamacare. Candidates also need a bachelor’s or master’s degree with coursework in health care or business administration, “demonstrated understanding” of consumer-oriented information-technology systems and the ability to communicate well and build teams.

The ad said the new director will also oversee new wellness initiatives for small businesses that buy coverage through the exchange, and network and payment “innovations designed to contain health care costs.”

The exchange hasn’t given a timeline for making the hire.

■ The exchange also released new enrollment numbers on Monday. It said 20,930 Nevadans had paid for coverage through its Nevada Health Link website as of March 8. That was up from 19,840 on March 3, and 19,142 on Feb. 26.

At the rate sign-ups are going, enrollment will likely max out at less than 25,000 by the March 31 deadline. That’s 21.2 percent of the exchange’s original target of 118,000 enrollees, and half of the revised goal of 50,000.

 

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